儿童小肠套叠与回结套叠的超声鉴别诊断

Differential Diagnosis of Small Bowel Intussusception and Ileocolic Intussusception in Children by Ultrasound

目的:探讨儿童小肠套叠与回结套叠的超声鉴别诊断及其意义,了解小肠套叠在儿童肠套叠中的占比。方法:回顾2011年9月至12月同一超声医生诊断的51例肠套叠,其中37例因外径<3.0cm和/或位于脐周、腹左侧诊断为小肠套叠;14例因起于腹右侧,外径大于或接近3.0cm诊断为回结套叠,比较分析两组的超声特征和转归。结果:72.5%(37/51)的肠套叠为小肠套叠。小肠套叠组:17男,20女,年龄7月14天9岁,中位数2岁,>2岁17例。37例共见48个肠套叠:初检32例为单发,4例各见2个、1例见4个多发肠套叠;2例1次复发、1例2次复发单个肠套叠。47个套叠外径1.2cm ~ 2.5cm,平均(1.8±0.3)cm.回结套叠组:10男,4女,年龄3月15天 3岁,中位数1~5岁,>2岁2例。14例均为单发。所有回结套叠均可见于右肋下切面肝肾间且与两者相贴,所有小肠套叠则否;14个单发回结套叠外径2.94.3cm,平均(3.5±0.3)cm, 35个单发小肠套叠外径1.4~2.5cm,平均(1.8±0.3)cm,两者上述位置与外径的差异均有统计学意义(P=0.000)。35例46个小肠套叠在初检或后续间隔为30~60min的反复监测中于293min内自动复位,其中1个瞬间消失不及测量;2例单发小肠套叠空气灌肠,结果为正常阴性。14例回结套叠空气灌肠均成功复位。结论:小肠套叠在儿童并不少见,本组其在肠套叠中的占比与成人相似。超声可通过其与回结套叠位置和外径大小的不同鉴别两者。因本组外径<2.5cm的小肠套叠多能自动复位,所以对这类患儿似可保守超声监测至确认其套叠复位。

Purpose: To differentiate small bowel intussusception (SBI) from ileocolic intussusceptions (ICI) in pediatric population with ultrasonography, and to investigate the proportion of small intussusception in children's intussusception. Methods: We reviewed 51 patients with intussusception diagnosed by one pediatric ultrasound doctor between September and December 2011. Among them, 37 were considered with SBI because the intussusception was atypically located in the paraumbilical or left abdomen and/or its diameter was <3.0cm. Fourteen were considered with ICI because the intussusception typically arose from right abdomen and its diameter was more than or close to 3.0cm. Their ultrasonographic features, management and outcome were retrospectively compared. Results: Of all the intussusceptions, 72.5%(37/51) were SBI. There were 17 boys and 20 girls in the SBI group, the median age was 2 years (ranged 7 months 14 days - 9years) and 17 patients were older than 2 years. There were 10 boys and 4 girls in the ICI group, the median age was 1.5 years (ranged 3 months 15 days -3 years) and 2 patients were older than 2 years. Regarding SBI, 48 intussusceptions were documented in 37 patients. Thirty-two patients were with an isolated intussusception each,4 patients with 2 respectively and 1 patient with 4 were documented at the first scanning. 4 isolated recurring intussusceptions were documented in 3 patients. The mean diameter of 47 SBIs was (1.8±0.3)cm (ranged 1.2cm-2.5cm). Regarding ICI,14 intussusceptions were isolated.All could be seen between or against the liver and the right kidney in the right subcostal section but none of their SBI counterparts could be seen in this location. The mean diameter of 14 isolated ICIs was (3.5±0.3)cm (ranged 2.9cm-4.3cm), which was larger than that of 37 isolated SBIs (1.8±0.3)cm (ranged 1.4cm-2.5cm). The differences in the location and diameter between SBI and ICI were with statistical significant (P=0.000). Forty-six SBIs in 35 patients repositioned spontaneously at the first scanning or the subsequent ultrasonographic monitoring per 30-60min within 293min, and one of them disappeared at the moment it was detected. Two patients with isolated SBI underwent air enema, but both had normal enema results. Air enema was successful in 14 patients with ICI. Conclusion: SBI is not uncommon in children, and its proportion in children's intussusception was similar to that in adults.SBI and ICI can be differentiated by ultrasonography. The location and diameter of the intussusception are the main criteria.Since most SBI smaller than 2.5cm can spontaneously reposition in this observation, patients with such SBI may be managed conservatively and the ultrasonographic follow-up seems to be sufficient for the subsequent monitoring to confirm spontaneous reposition.